Poor health care access not to blame for high death rates among American Indian women with breast cancer

Photo of Mother's Wisdom Advisory Council © 2009 UC Regents
Advisory Council, clockwise from back row left: Linda Navarro (Cahuilla-Shasta heritage), Marlene von Friederichs-Fitzwater, Deyetta Pickens-Gist (Miwok-Maidu), Barbara Hart (Pawnee), Tanya Erck (Comanche) and Kellie Stevens (Paiute). Not pictured: Joleen Rodriguez (Miwok) and Billie Blue Elliston and Phyllis Cleveland (Ione Bank of Miwok)

Culturally sensitive educational approach increases mammography rates

Low breast cancer screening and survival rates for American Indian and Alaska native women have more to do with cultural beliefs than with barriers such as access to health care, a new UC Davis study has found.

Researchers with UC Davis and the Turtle Health Foundation also found that more holistic educational interventions designed by American Indian and Alaska native women prompted women in those communities to seek mammograms and to change unhealthy eating and sedentary lifestyles.

"The results highlight the significance of cultural beliefs and attitudes when designing effective cancer-risk-reduction and cancer-control interventions,” said Marlene von Friederichs-Fitzwater, assistant adjunct professor or hematology and oncology and director of the UC Davis Outreach, Research and Education Program. “Access to mammography screening and quality follow-up care are critical, but we learned that access is not the only barrier to improving breast cancer screening rates among AI/AN women."

Breast cancer is now the second-leading cause of cancer–related deaths among American Indian and Alaska native women, with mortality rates that could be cut by more than 30 percent if screening were increased to recommended levels.

American Indians and Alaska natives have the lowest five-year survival rate compared with other ethnic groups, and are less likely than non-Hispanic white women to be diagnosed with the disease before it has spread to other areas of the body.

Photo of Dr. VonFriederich Fitzwater © 2009 UC Regents"The results highlight the significance of cultural beliefs and attitudes when designing effective cancer-risk-reduction and cancer-control interventions."
— Marlene von Friederichs-Fitzwater, director of the UC Davis Outreach, Research and Education Program

The UC Davis and community researchers identified several important cultural and tribal issues that affect cancer-control strategies. For example, in some native languages, the literal translation for cancer is “the sore that never heals,” reflecting a belief that cancer is incurable. Among some groups, cancer carries a stigma, which can have a negative impact on cancer screening educational programs and interventions to reduce risk.

“My experience with people who did not survive their cancer is that many of them didn’t tell anyone except for those very, very close to them,” said Linda Navarro, co-chair of the project and a member of the Torres Martinez Desert Cahuilla tribe. “One of the reasons is they didn’t want to be a burden to anyone.”

The study, funded with a grant from the California Breast Cancer Research Program, resulted in a more culturally appealing breast cancer morbidity and mortality reduction approach called the “Mother’s Wisdom Breast Health Program.” The program was disseminated using traditional storytelling, talking circles and other traditional communication methods.

A 12-member American Indian advisory council with representatives from eight tribes developed the program, multi-media, which includes an interactive DVD to educate women about breast health, cancer diagnosis and treatment and the importance of a healthy diet and exercise. The DVD, which used cultural music and art and historical links to traditional diets and physical activity, was tested with 161 American Indian and Alaska native women.

UC Davis and Turtle Health Foundation expand partnership

Photo of Linda Navarro ©  2009 UC RegentsThe UC Davis Cancer Center has formalized and expanded a partnership with the nonprofit Turtle Health Foundation to improve cancer education, research and training for American Indian tribes and tribal communities.

Click here to learn more.

The study found that participants who watched the DVD significantly increased their knowledge about breast health and the importance of early detection. Researchers also determined that 118 women who watched the DVD said they would get a mammogram, and nearly all of them (112) had done so within a year afterward.

Von Friederichs-Fitzwater said the study will help researchers develop other culturally appropriate interventions to increase awareness and screening of all types of cancer in American Indian/Alaska native communities. 

Navarro added that the DVD is being used throughout native communities including at their health fairs, workshops, tribal functions and even intimate family gatherings.

In addition, an American Indian "ribbon of life" was designed with funding from Susan G. Komen for the Cure and distributed to more than 8,000 women at pow wows, tribal health gatherings and other meetings to increase breast cancer awareness among American Indian and Alaska native women.

The results of this study were presented at the August 2009 Native Health Conference in Portland, Ore.